Provider Demographics
NPI:1679116230
Name:GREEN SQUARED
Entity Type:Organization
Organization Name:GREEN SQUARED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:K
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-822-8370
Mailing Address - Street 1:2418 DANVILLE RD SW STE C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4278
Mailing Address - Country:US
Mailing Address - Phone:256-822-8370
Mailing Address - Fax:
Practice Address - Street 1:2418 DANVILLE RD SW STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4278
Practice Address - Country:US
Practice Address - Phone:256-822-8370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREEN LIFE CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-25
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service